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Gardner-Webb UniversityDigital Commons @ Gardner-Webb University
Nursing Theses and Capstone Projects Hunt School of Nursing
7-2016
Outcomes of Peer Mentoring at an AssociateDegree Nursing ProgramMelissa B. HarperGardner-Webb University
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Recommended CitationHarper, Melissa B., "Outcomes of Peer Mentoring at an Associate Degree Nursing Program" (2016). Nursing Theses and CapstoneProjects. 243.https://digitalcommons.gardner-webb.edu/nursing_etd/243
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i
Outcomes of Peer Mentoring at an Associate Degree Nursing Program
by
Melissa B. Harper
A thesis submitted to the faculty of
Gardner-Webb University Hunt School of Nursing
in partial fulfillment of the requirements for the
Master of Science in Nursing Degree
Boiling Springs, North Carolina
2016
Submitted by: Approved by:
______________________________ ______________________________
Melissa B. Harper, BSN, RN Cindy Miller, PhD, RN
______________________________ ______________________________
Date Date
ii
Abstract
Nursing students have described clinical experiences as being stressful, yet the
application of classroom knowledge to the clinical health care setting is a requirement.
The purpose of this mixed-method study is to compare students’ perceptions of the peer
mentoring leadership experience (PMLE) and the student charge nurse experience
(SCNE). The PMLE was piloted at a southeastern community college’s associate degree
nursing (ADN) program. Hand-selected PMLE second-year nursing students (n=5) were
paired with hand-selected PMLE first-year nursing students (n=5) for medical/surgical
clinical rotations. The ADN program’s purpose for these clinical rotations was to provide
a mutually beneficial mentoring experience. The remaining second-year nursing students
(n=25) registered in the health system concepts course participated in the SCNE in which
one-on-one time was spent with an on-duty designated floor charge nurse during
medical/surgical clinical rotations. These second-year student participants spent
additional time in a student charge nurse role meeting course management and leadership
objectives while overseeing first-year students’ (n=37) patient care with clinical faculty
as resources. Students voluntarily completed a survey indicating their perceptions of how
learning objectives for the clinical experience were met for client advocate, educator, and
caregiver, prioritization of client care, time management, communicator, leader, multi-
disciplinary team relationship builder and self-confidence. Descriptive analysis was
completed for the quantitative data and qualitative data was reviewed with grouping of
themes. Results from the study indicated that the PMLE respondents perceived their
experience met the individual course objectives more than the compared SCNE
respondents. Keywords: Peer mentoring, student charge nurse
iii
Acknowledgements
I would like to convey my appreciation to Dr. Suzanne Zentz, Dr. Kurtz, and Dr.
Alverson for allowing the use of modifying their survey tool to conduct this study. I
express my gratitude to the participants of this study for their willingness to participate in
my research. I would like to thank my nursing friends and coworkers that have assisted
in guiding and emotionally supporting me during my nursing education. I would like to
express my deepest gratitude to my husband, Craig Harper for his loving support. Thank
you to my son and daughter-in-law, Nick and Deven Neal, and my daughter, Natalie
Harper, for their sacrifices that allowed me to pursue my educational goals. Thank you to
all my extended family for helping with child care, encouragement and reminding me to
not give up along with a special thank you to my parents, Pat and Wayne Kluttz; my
cousin, Lori Johnson; and Mister Mike Cole. Without all of you, my educational goals
would not have been accomplished.
v
Table of Contents
CHAPTER I: INTRODUCTION
Significance....................................................................................................................1
Problem Statement .........................................................................................................2
Purpose ...........................................................................................................................2
Theoretical or Conceptual Framework ..........................................................................3
Research Question .........................................................................................................7
Definition of Terms........................................................................................................7
CHAPTER II: RESEARCH BASED EVIDENCE
Literature Related to Statement of Purpose .................................................................11
Strengths and Limitations of Literature .......................................................................30
Summary ......................................................................................................................31
CHAPTER III: METHODOLOGY
Study Design ................................................................................................................33
Setting and Sample ......................................................................................................33
Design for Data Collection ..........................................................................................36
Measurement Methods .................................................................................................37
Data Collection Procedure ...........................................................................................37
Protection of Human Subjects .....................................................................................37
Data Analysis ...............................................................................................................38
CHAPTER IV: RESULTS
Sample Characteristics .................................................................................................40
Major Findings .............................................................................................................41
vi
Summary ......................................................................................................................59
CHAPTER V: DISCUSSION
Implication of Findings ................................................................................................61
Application to Conceptual Framework ........................................................................63
Limitations ...................................................................................................................64
Implications for Nursing ..............................................................................................64
Recommendations ........................................................................................................64
Conclusion ...................................................................................................................65
REFERENCES ..................................................................................................................66
vii
List of Figures
Figure 1: Key Concepts for Peer Mentoring ........................................................................6
viii
List of Tables
Table 1: Survey Distribution and Return Data .................................................................40
Table 2: Participation Numbers per Student Year Level and Clinical Experience ............41
Table 3: Second-year PMLE Individual Item Mean Scores and Overall Mean Score ......42
Table 4: First-year PMLE Individual Item Mean Scores and Overall Mean Score...........44
Table 5: First- and Second-year PMLE Aggregate Mean Scores and Overall Mean
Score ..................................................................................................................................46
Table 6: Second-year SCNE Individual Item Mean Scores and Overall Mean Score .......48
Table 7: First-year SCNE Individual Item Mean Scores and Overall Mean Score ...........50
Table 8: First- and Second-year SCNE Aggregate Mean Scores and Overall Mean
Score ..................................................................................................................................52
1
CHAPTER I
Introduction
Nursing students have expressed one aspect of the nursing program that causes
the most apprehension is the clinical experience (Sharif & Masoumi, 2005). Clinical
experience involves nursing students taking academically learned knowledge from the
classroom and putting it into practice within a health care setting. One strategy utilized to
aid nursing students in the clinical experience has been peer mentoring, also called peer
mentored learning. Peer mentored learning can be strategically planned, but often times
it happens spontaneously (Henning, Weidner, & Marty, 2008). A study conducted during
a nursing clinical experience found that nursing students reported feeling less anxious and
were able to increase interactions and collaboration more when taught by peers (Iwasiw
& Goldenberg, 1993). Whitman and Fife (1988) found another benefit to peer mentored
learning was the mentor’s knowledge was reinforced through the process of teaching to a
peer. A third benefit to peer mentored learning was relief from faculty burden (Zentz,
Kurtz, & Alverson, 2014; Peer, 2015).
Significance
The National League for Nursing’s (NLN) Annual Survey of Schools of Nursing
Academic Year 2011-2012 indicated nursing programs continue to be impeded by the
shortage of nursing faculty, and this continues to compound the shortage of nurses. In
the fall of 2012, associate degree nursing (ADN) programs rejected 45% of qualified
applications (NLN, 2013). While the nursing faculty shortage remains burdensome, the
nursing program instructors are expected to provide clinical experiences to enhance
learners’ education by bringing health concepts and professional roles out of the
2
classroom and into the clinical environment. Ammon and Schroll (1988) found peer
assisted learning (PAL) reduces the workload on clinical instructors, and improves the
overall clinical experience for students.
Problem Statement
The problem remains that there is little research on the outcomes of peer
mentoring, specifically in ADN programs. Many authors have presented studies of the
implementation of peer mentoring in undergraduate or graduate degree nursing programs
(Aston & Molassiotis, 2003; Isaacson & Stacy, 2004; Peer, 2015; Li, Wang, Lin, & Lee,
2011; Zentz et al., 2014; Sims-Giddens, Helton, & Hope, 2010; Rapaport, 2014;
Christiansen & Bell, 2010; Jacobs, Atack, Ng, Haghiri-Vjeh, & Dell’Elce, 2015; Joseph,
2009; Riley & Fearing, 2009; Roberts, Vignato, Moore, & Madden, 2009; Joubert & de
Villers, 2015; Iwasiw, Goldenberg & Andrusyszyn, 2009; Sprengel & Job, 2004). These
studies include the implementation of peer mentoring as resources to enhance the
learning experience of both the mentor and mentee, but none of them focus on peer
mentoring of ADN students.
Purpose
The purpose of this study was to compare students’ perceptions of the peer
mentoring leadership experience (PMLE) and the student charge nurse experience
(SCNE). Findings from this Outcomes of Peer Mentoring Study could assist nurse
educators in ADN programs to determine whether to include PMLE and/or SCNE as part
of the curriculum.
3
Theoretical or Conceptual Framework
The framework for this study was based on Kirkham and Ringelstein’s (2008)
conceptual framework of the student peer assisted mentoring (SPAM) model. The
researchers used the SPAM model as an approach for supplemental instruction with
students involved as the peer mentors. The SPAM model’s main objectives were to
increase student performance and to increase retention rates. The objectives were
accomplished through developing a feeling of community through participation in
networking leading to the creation of study groups; providing a non-intimidating
atmosphere which was advantageous to learning; providing study and erudition strategies
that could be utilized in other areas of learning; and avoiding the formation of a remedial
program that might produce negative implications.
Requirements for Mentoring
The student mentors were chosen based on the individuals’ proficiency in several
areas. Requirements for student mentors included being able to demonstrate an
understanding of the academic course content and being able to communicate problem-
solving skills. The student mentors were also chosen based on having a commitment to
the concept of mentoring, a positive academic standing, strong relational abilities, strong
computer knowledge, ability to teach knowledge, patience and reverence for the
educational needs of another person, willingness to promote the development of another
person’s educational advancement, being an active member of the mentoring network
team, and having effective communication skills (Kirkham & Ringelstein, 2008).
4
Benefits
The SPAM program was beneficial not only to the student mentee, but also to the
student mentor. For the student mentee, the program was focused on the individual’s
learning needs and encouraged active problem solving. A benefit for the mentor included
reinforcement of nursing education through teaching peers strategies for problem solving.
Mentors also learned to develop skills for communicating, leadership, and multi-
disciplinary team relationship building (Kirkham & Ringelstein, 2008).
Principles
SPAM’s program had four main principles that were helpful in determining the
success. These principles were described as the four ‘Cs’ because they included
commitment, clarity of purpose, communication, and confidentiality. The first ‘C’,
commitment, referred to the student mentor being willing to take on the role of assisting
another student so that the academic leader who has time constraints involved with
aspects of the program could be less burdened. The second ‘C’, clarity of purpose,
referred to making sure the outcomes were identified so the objectives could be well
developed and evaluated. The third ‘C’, communication, referred to the information
being provided for both the mentor and mentee about what to expect throughout the
program’s process. The fourth ‘C’, confidentiality, referred to a clear understanding of
the importance to safeguard the mentor-mentee relationship (Kirkham & Ringelstein,
2008).
Objectives
Objectives gave structure to the SPAM program. In order to develop the
objectives, there was a pre-evaluation administered that was intended to identify specific
5
needs of the individual student prior to beginning the student peer assisted mentoring
program. The objectives were created with three specific goals in mind: (1) Direction to
provide guidance of where learning was to be directed and to develop a clear
understanding of what the mentee wanted to achieve, (2) Motivation to provide both
student mentor and student mentee with goals to aim at accomplishing, and (3)
Reinforcement was accomplished during development of feelings of success. In order to
determine that the SPAM program was proceeding appropriately in order that it allowed
for objectives to be met there were feedback and evaluation processes in place throughout
the semester. The feedback and evaluations were required to be completed by both the
mentor and mentees (Kirkham & Ringelstein, 2008).
Measurement of Success
Success of the SPAM program was demonstrated with the mentee passing the
course while developing deep learning and problem solving skills all the while increasing
self-confidence. The peer mentor’s success was demonstrated by the recognition they
gained by being an active participant, developing deep learning skills, and expanding on
their skills of communication, leadership and relational abilities. The SPAM program
was created to increase student performance and indirectly to have a positive influence on
student retention by increasing motivation (Kirkham & Ringelstein, 2008).
Utilization of Concepts
The key concepts from the SPAM model that were relevant to the Outcomes of
Peer Mentoring Study included the utilization of peer mentoring to increase the first-year
student mentee’s deep learning of being a client advocate, educator and caregiver;
problem solving skills defined as prioritizing client care and time management; and self-
6
confidence. Key concepts from the SPAM model that peer mentoring benefited the
second-year student mentor included reinforcement of nursing education through
teaching peers strategies for problem solving defined as prioritizing client care and time
management. They also learned to develop skills for communicating, leadership, and
multi-disciplinary team relationship building. Key concepts of the peer mentoring are
outlined through a Conceptual-Theoretical-Empirical (CTE) structure in Figure 1.
Figure 1: Key Concepts for Peer Mentoring. CTE diagram of Kirkham & Ringelsteins’
SPAM model key concepts related to peer mentoring.
2nd-year Mentor2nd-year Mentor•Determined how to explain stategies for problem-solving
•Developed skills for communicating, leadership, & multi-discplinary team relationship building
sdads
sdads
1st-year Mentee1st-year Mentee
•Developed deep learning & problem solving skills
• Increased self-confidence
7
Research Questions
What advantages did the participating students report concerning the PMLE?
What advantages did the participating students report concerning the SCNE?
What disadvantages did the participating students report concerning the PMLE?
What disadvantages did the participating students report concerning the SCNE?
What suggestions did the participating students report for a possible future student
PMLE?
What suggestions did the participating students report for future SCNE?
What are the students’ perceptions of the outcomes of a peer mentoring leadership
experience compared to a student charge nurse experience?
Definition of Terms
Throughout this thesis, specific terms were used in describing Kirkham and
Ringelstein’s (2008) conceptual framework of the SPAM model. The key concepts from
the SPAM model that were relevant to the peer mentoring pilot study included the
utilization of peer mentoring to increase student performance and was a supplemental
instruction strategy with students actively involved as the mentors. Additional terms
utilized in this thesis to describe important aspects of this study are health care setting
and student charge nurse.
Peer mentor The noun ‘peer’ was stated as “one of the same rank, quality,
endowments, character, etc.; an equal; a match; a mate” ("Peer," n.d.).
“Mentoring is just-in-time help, insight into issues, and the sharing of expertise,
values, skills, and perspectives” (Educause, 2016). The terms mentor and mentee
were also utilized throughout this thesis. Mentee was defined as “one who is
8
being mentored” ("Mentee," n.d.). Mentor was defined as “someone who teaches
or gives help and advice to a less experienced and often younger person”
("Mentor," n.d.).
Performance The word “performance” was derived from the Late Middle
English-Middle French parfourmaunce ("Performance," 2016). Performance was
defined as “the act of performing; of doing something successfully; using
knowledge as distinguished from merely possessing it” ("Performance," 2016).
Supplemental The word “supplemental” was derived from “supplement” which
was from the 1350-1400; Middle English and Latin supplēmentum, which meant,
“that by which anything is made full” ("Supplement," 2015). “Supplemental” is
defined as “added to something else to make it complete” ("Supplemental,"
2016).
Strategy The word “strategy” derived from the Greek word stratçgos; which
derived from two words “stratos” which meant army and the word “ago” which
was ancient Greek for leading, guiding, or moving. Strategy was the means by
which outcomes were deliberately and methodically pursued and obtained over
time. (El-Kadi, n.d.). The SPAM model was a strategy put into place specifically
as a supplemental instruction to increase student performance. The SPAM model
was beneficial not only to the student mentee, but also to the student mentor.
Mentors’ benefits included reinforcement of learning through teaching mentees
strategies for problem solving. Mentors also learned to develop skills for
communicating, leadership, and multi-disciplinary team relationship building.
SPAM worked on two distinct levels, one for the student mentees and the other
9
for the student mentors. For the student mentees, success was translated into (a)
achieved passing grade (or better); (b) developed deep learning and problem
solving skills; and (c) increased levels of confidence and motivation. The peer
mentor’s success was demonstrated by the recognition they gained by being an
active participant, by the development of deep learning skills, and by expansion
on their skills as a communicator, leader and interpersonal skills.
Health care setting Another specific term utilized throughout this thesis included
“health care setting”. René Dubos stated, “Health is primarily a measure of each
person's ability to do and become what he wants to become” (as cited in The Free
Dictionary, 2016). Care referred to “the services rendered by members of health
professions for the benefit of a patient” ("Care," 2016). Setting was defined as the
place and conditions in which something happens or exists ("Setting," n.d.).
Student charge nurse The last term utilized throughout this thesis was “student
charge nurse”. Student was defined as “a person who studies something”
("Student," n.d.). Strategies for Nurse Managers (2016) described the skills the
charge nurse must possess included being technically proficient, knowing other
staff and looking out for their welfare, being proficient in communication toward
staff, ensuring staff understand tasks and accomplish them while being
supervised. The charge nurse also must make sound and time conscious
decisions, be a good role model and help the nursing staff develop a sense of
responsibility (Strategies for Nurse Managers, 2016).
10
Conducting this pilot study on the outcomes of peer mentoring at an ADN
program was focused on utilization of key concepts from Kirkham and Ringelstein’s
(2008) conceptual framework of the SPAM model to identify students’ perceptions of a
PMLE in comparison to students’ perceptions of a SCNE. Findings from this study could
assist nurse educators in ADN programs to determine whether to include PMLE and/or
SCNE as part of the future curriculum, modify or discontinue the experience(s).
11
CHAPTER II
Research Based Evidence
Literature Related to Statement of Purpose
The requirements of nursing programs have been described as stressful by
students. The clinical aspect of the nursing program is no exception to this anxiety-
producing time in nursing students’ education. Studies have shown that peer mentoring
has been one strategy to benefit both mentors and mentees. Studies have also shown
student charge nurse experiences to be beneficial, while providing opportunities to apply
leadership and management theory in the clinical health care setting.
A systematic literature review of health-related electronic databases was
conducted including Cumulative Index for Nursing and Allied Health Literature
(CINAHL) Plus, ProQuest, ProQuest Educational Journals, ProQuest Dissertations &
Theses, and Science Direct College Edition-Health & Life Sciences Collection to obtain
articles. Peer mentoring had similar terminology used by other authors such as peer
assisted learning (Zentz et al., 2014), peer coaching (Peer, 2015), peer tutoring (Joseph,
2009) or peer teaching (Secomb, 2008). Single words, phrases or a combination of the
key words ‘peer assisted learning’, ‘peer learning’, ‘peer mentoring’, ‘peer coaching’,
‘clinical’, ‘clinical setting’, ‘clinical teaching’, ‘nursing students’, ‘student nurse clinical
experience’, ‘student charge nurse’, and ‘nursing student leadership’ were utilized to
search the literature. Inclusion criteria required the articles to be published between
2004-2016 in full-text English and from peer-reviewed articles. Twenty-four peer
reviewed journal articles were retrieved from the literature review. Twelve articles were
selected for the purpose of this study. Seven articles related to peer mentoring strategy,
12
yet there was no specific literature on PMLEs for ADN programs. Two articles related to
SCNEs for undergraduate nursing degree programs. One article related to a clinical
experience that included peer mentoring and student charge nurse leadership. Two
systematic review journal articles were also utilized. Review of written nursing
instructional textbook indexes was conducted searching for sections related to this
study’s defined research terminology and two were used for the purpose of this literature
review.
Peer Mentoring
Li et al. (2011) explored the advantages of peer mentoring strategy on reducing
students’ stress level by having mentors guide peer students at the same grade level
during medical/surgical clinical practice. This quasi-experimental study was conducted
in southern Taiwan at a university’s undergraduate program and involved 66 junior level
nursing students, with 34 of those students in the experimental group (17 mentors and 17
mentees), and 32 students in the control group that were all enrolled in the same
medical/surgical nursing class. The mentors each held a junior nursing college degree
and a registered nurse (RN) license with prior clinical experience. The purpose of the
study was to have mentors guide peer students at the same grade level during
medical/surgical clinical practice to explore the advantages of the peer mentoring strategy
on reducing the students’ stress level. Two clinical teachers involved as participants were
individually assigned to a clinical group of eight to ten students. The clinical course was
three days per week for four weeks. In the experimental group, the mentors and mentees
were allowed to pair themselves during the first week of clinical orientation. The
following weeks of clinical experiences involved the mentor and mentee being assigned
13
one patient each. Mentor and mentee had to learn each other’s patients through
discussions about care issues and sharing their experiences. The mentors could assist
mentees in basic skills and nursing skills such as tube or mouth care. There were further
objectives required such as having conversations at least once a week during the clinical
rotation and then communicating with each other after rotation via telephone or e-mail.
Researchers met with the mentors and mentees once a week also. The Perceived Stress
Scale (PSS) for nursing students in clinical practice was used to collect data at, before,
and after clinical practice. The PSS included 29 items, six scales, ranked on a 6-point
rating scale for stress levels. Mentors and mentees alike provided advantages and
disadvantages as part of the feedback. Advantages mentioned by mentees included
feeling supported with an increased sense of security when working with a mentor.
Mentors also expressed advantages of the experience such as while observing mentees
the mentors themselves learned foundational nursing techniques. Disadvantages
expressed included from a mentor that the mentee displayed a lack of initiative and
motivation to problem solve. Results from the study showed there were no significant
differences in the stress scores between the experimental and control group. Limitations
mentioned in this study included not having enough students with prior clinical practice
experience (each class had five to ten students with the experience) and having students
from only one nursing school restricted the sample size. Cross-school collaboration is
suggested for further studies. Another limitation mentioned was the personal
characteristics such as motivation, self-confidence, enthusiasm, and openness may have
been possessed by all the students and could have skewed the results. A suggestion in the
conclusion is to have a clinical instructor with experience to support and encourage
14
mentor and mentee students. Review of this study showed use of peer mentoring by the
same year level of students in an undergraduate degree nursing program and revealed no
significant difference in anxiety between the control and experimental groups.
Zentz et al. (2014) evaluated the effectiveness of peer assisted learning (PAL) in
the clinical health care setting and determined students’ perceptions of fulfilling the roles
of professional nurse and perceived effect related to anxiety. Over a two-year time
frame, 342 students participated in a PAL model at a private university. Senior Bachelor
of Science in Nursing (BSN) students were paired to assist sophomore BSN students
during their fundamentals clinical experience. During this mixed-method study that was
conducted during several semesters over a two-year period, all senior students registered
in the capstone course and all sophomore students involved in the clinical portion of the
fundamentals course were invited to participate. The mentoring experience included the
senior mentors assisting for two sessions: one being in the virtual nursing learning center
and one being in the clinical health care setting. The virtual nursing learning center
session consisted of two senior mentors assisting a group of approximately 25 sophomore
mentees. During the clinical health care setting, one to two senior mentors were assigned
to each clinical group, which contained eight to 10 sophomore mentees. The senior
mentoring objectives included for them to journal about their experience. They were also
to help sophomore students with physical assessments, hygiene care, and procedures plus
attend pre- and post-conferences. The survey conducted included items rated using a 5-
point Likert-type scale, and items requiring an open-ended response. Quantitative data
was analyzed using Statistical Package for Social Sciences (SPSS) software version 18
while experts in the field of nursing education reviewed qualitative data. Advantages
15
provided by the majority of sophomore mentees were a reduction in anxiety (79.6%),
increased self-confidence (78.1%), and increased learning (74.2%). Additional feedback
from the sophomore mentees included their perceptions that senior mentors demonstrated
the professional roles of caregiver (82%), teacher (79.1%) lifelong learner (68.4%),
manager (56.8%), and research consumer (48.5%). Advantages provided by the senior
mentors included the PAL experience allowed them to demonstrate their professional
roles of teacher (94.8%), lifelong learner (86%), caregiver (85.3%), manager (69.1%),
and research consumer (46.3%). Sophomore student mentees (80%) perceived that
senior student mentors were given an opportunity to act as caregivers and teachers
through the PAL experience. The student senior mentors (95%) perceived that during the
PAL experience they were demonstrating teaching role, which reinforced their own
knowledge. The study supported PAL as an operative teaching strategy for learning
nursing skills and applying the roles of the professional nurse. Weakness of preparation
of the students and faculty for the PAL program was pointed out through the sophomore
and senior students’ reflection comments. Recommendations from the researchers of this
study included examination of diversity and learning styles on the PAL model. They also
suggested examination of faculty perception of PAL as to whether the model achieved
learning objectives and relieved faculty burden. Research was focused on peer mentoring
in an undergraduate degree nursing program with a lack of attention on ADN programs.
Sims-Giddens et al. (2010) assessed the outcomes from a pilot project that
included using student peer mentoring as one strategy to provide a network of support to
students placed in community-based agencies to work with vulnerable populations. This
was a 16-week student-to-student peer mentoring teaching project with nursing students
16
from three different levels of education participating. The first level involved a Master of
Science in Nursing (MSN) student that worked in collaboration with the second level of
student, which included Registered Nurse-to-Bachelor of Science in Nursing (RN-to-
BSN) students in a grant-funded community-based agency. This agency was staffed with
social workers and counselors, but not RNs due to a lack of funds. The agency had a
long-standing collaboration with the department of nursing to provide nursing needs for
the agency, for example home visits to supply health education and assessments of the
family members. There were no policies and procedures in place for the nurses providing
these services in the agency, but nursing faculty were serving as clinical supervisors for
those students. The graduate student in the MSN nurse educator program was hired by
the university (via an internal grant) to serve as facilitator for the peer mentoring group
and as liaison between the community-based clinical agency and the nursing faculty. The
MSN student’s objectives included to increase knowledge about mentoring and to gain
insight into the mentoring method. There were two RN-to-BSN students completing
their capstone leadership/management course involved in this project. These two RN-to-
BSN students designed and implemented organizational policies and procedures for
nursing care of clients served by the community agency. There were two additional RN-
to-BSN students completing their community health course involved in this project.
These two RN-to-BSN students were tasked with performing community assessments for
an at-risk population and their health care needs. They also made home visits that
included implementing health care interventions, teaching, and making referrals to other
health care providers when deemed appropriate. Advantages and disadvantages of this
model were discussed based on feedback from student journals, reflective comments, and
17
pre- and post-test evaluations. Quantitative and qualitative methods were used to
evaluate the project. A peer mentoring evaluation tool was developed by a researcher
and administered as pre- and post-project experience. The evaluation tool contained 26
statements, with a Likert scale format, related to mentoring and mentoring experiences.
In addition, the course instructors conducted qualitative interviews of the group post
experience. The interview notes were recorded by the researchers and examined for
similar themes. The graduate student provided feedback through a reflective journal with
the major take-away being that mentoring was mutually supportive, mutually educational,
and provided a nurturing relationship that included respect, role modeling, commitment,
collegiality, and encouragement. The outcomes were positive for this peer mentoring
project and led the faculty to expand the project to include an additional agency servicing
the high-risk homeless population and lacking a nursing presence. They have expanded
the level of students involved in the project to include fourth-year baccalaureate students
in addition to the RN-to-BSN and master’s students. Suggestions for future examinations
were to evaluate the student-to-student peer-mentoring process with a study including the
difference between self-selected and hand-selected assigned mentoring groups. A
longitudinal study for examining the outcomes of peer-mentoring relationships on
students’ professional nursing careers was also suggested. They also suggested a
refinement of tools for the effective measurement of mentoring outcomes. This study
was focused on a variety of student degree levels, but did not include ADN level
students.
Rapaport (2014) evaluated the outcomes from peer mentoring in a nursing
program that consisted of licensed practical nursing (PN1) students and RN students at a
18
community college. The faculty randomly paired first semester PN1 students with RN
students. The pairs met for the first time at a social event hosted with the objective to
allow time for interaction and becoming familiar with one another prior to clinical or lab
experiences. The RN student mentors had objectives to meet for leadership skills classes
such as having designated time with the mentee in fundamentals skills lab, gerontology
clinical, and also one-on-one meetings periodically throughout the semester.
Confidential surveys were given to both the mentors and mentees to evaluate the peer
mentoring experience. There were both advantages and disadvantages provided as
feedback. An advantage mentioned by 70% (17 of 24) of the RN student mentors was
the benefit from working with a novice student and over 80% (20 of 24) stated they
would probably utilize their mentoring experiences in future career experiences. ‘Time
and scheduling’ was the biggest issue listed as a disadvantage. Suggested modifications
to the peer mentoring program included using social media tools to increase student
engagement and interactions along with development of biweekly mentoring gatherings
to support collaboration and open dialogue. This study’s peer mentoring focused on
randomly paired PN1 students with RN students, but did not research ADN peer
mentoring.
Christiansen and Bell (2010) examined the outcomes of a peer learning initiative
created to facilitate mutually supportive learning relationships between undergraduate
student nurses in the practice setting. In this interpretive qualitative designed study
conducted in the United Kingdom, focus group interviews were utilized to collect
interactive and situated discourse from nursing students who had recently participated in
peer learning partnerships (n=54) within the past six months. Data was collected over an
19
18-month time frame. The participants were assigned to a focus group of between nine to
16 participants and were facilitated to focus on their experience of acting as a senior
mentor or junior mentee. Findings suggested active support from peer senior student
mentors reduced the feelings of social isolation for the novice junior student mentees
involved with first time clinical rotation experiences. The results also indicated the
experience with peer mentors assisted the mentees to cope more effectively with the
challenges faced and reduced the factors that have an impact on attrition. This study
pointed out some limitations as being the fact that the participants had self-selected for
participation in the peer learning partnership initiative and were invested in the
experience. Additional limitations of this study included a lack of seeking the
perceptions of the mentors and mentees. This study focused on undergraduate degree
nursing students that were self-selected for participation, but not ADN nursing students.
Joubert and de Villers (2015) conducted a qualitative descriptive design study
using the nominal-group technique for data collection with a facilitator and 67 members
interested in or involved with a specific section of the problem being examined. The
mentoring program was conducted for a year, involved 12 undergraduate post-basic
critical care mentors along with 55 third-year undergraduate nursing students in the
critical care clinical setting. The final participants included in the research study were
five (5 of 12) mentors and fourteen (14 of 55) mentees that were placed in separate
nominal groups, but participants could choose an Afrikaans or English group.
Participants were given time to contemplate and transcribe their responses as the
facilitator asked the questions which included transcribing the participants’ experience of
the mentoring program along with how it could be improved. Using MindManager
20
Software from Mindjet, a consensus method to obtain feedback from the participants was
obtained regarding the learning experiences. The five categories the mentors expressed
as important were allocation, correlation and application of theory in practice, mentee
attitude, learning experience, and reassurance and trust. The five categories the mentees
expressed as important were availability, knowledge and competency, mentor attitude,
mentor support, along with theory and practice integration. Findings included that
mentors, mentees, critical care nursing staff, and managers should be prepared and
oriented to the mentoring program. Other feedback gleaned included mentees requesting
the ratio of mentors to mentees be changed to two mentors per mentee, yet mentors had
suggested one mentor to three mentees per month per critical care unit. Mentees also
requested a change for full-time mentoring for a week. In addition, both the groups of
mentors and mentees provided feedback that they benefited from the mentoring program.
Limitations were related to the number of topics and problems that could be included in
the feedback session; the restricted opportunity for participants to contemplate the
problems; and the absence of anonymity. Historically, research has focused on peer
mentoring involving undergraduate or graduate degree nursing programs with either
randomly selected or self-selected participants.
Another study focused on peer mentoring was Roberts et al. (2009) examination
of the perceived results reported by nursing students after review of skills and practice in
a simulation laboratory with peer mentors. Freshman nursing student mentees were
mentored by senior nursing student mentors in four-hour “Skills-a-Thon” sessions
conducted in the simulation laboratory at an ADN nursing program at a community
college in southern California the first week of return from summer or winter breaks.
21
The purpose was to facilitate skill-building reacquisition and to boost confidence in
mentees while assessing and improving the skills of mentors over three sessions. The
mentees had learned the skills in the first semester during the beginning four weeks of
school and were able to apply this training to actual patients in a health care setting
during the following 12 weeks. Prior to beginning the “Skills-a-Thon”, seniors were
instructed on mentoring and skill competencies with review from a course textbook that
utilized evidence-based practice criteria. Skill examples included in the “Skills-a-Thon”
were indwelling catheterization, nasogastric tube insertion and feedings, injectable
medications, physical assessments, and sterile dressing changes. After the first two
sessions of the “Skills-a-Thon”, faculty designed the third simulation differently for
inclusion of more difficult skills to recall. Mock health care setting stations were
prepared with hospital beds, Manikins for patients, supplies, and physician order sheets.
Since this was not a testing of skills format the mentees were accustomed to, they were
allowed to refer to textbooks for procedure clarifications. Each station had one faculty
member as a facilitator and one of ten senior mentors while allowing a maximum of 20
mentees to rotate through with allowance of 20 minutes per station. The skills mock
sessions took an estimated three of the four allotted hours. Mentors assisted the mentees
to work through the procedures and to use critical concepts while being checked off on
the skills. The mentees and mentors completed an evaluation at the end of the mock
skills session that included focus on available time, helpfulness of seniors, and
conduciveness of the environment to learning. Positive feedback from participants
included improved performance and increased confidence with the hands-on application
provided in a non-threatening environment. Senior mentors’ feedback for improvement
22
included a more in-depth training prior to mentoring. Negative feedback included
environmental issues, specifically the noise level and crowded space. Peer mentoring
was shown as helpful in the simulation setting. Further investigation into the effects of
peer mentoring in both the clinical health care setting and simulation setting would help
nurse educators to determine direction of modifications needed to the curriculum.
Sprengel and Job (2004) conducted a study with the purpose of examining the
perceived effects of peer mentoring on stress in an undergraduate degree nursing
program. Thirty sophomore mentors were paired with 30 freshmen mentees in their first
clinical course and all were oriented to their respective roles and responsibilities for
working together in the clinical health care setting. Prior to the first clinical experience,
the mentees were administered the Kleehammer, Hart, and Keck Clinical Experience
Assessment which included 16 items, eight of which were related to anxiety. After the
clinical experience, both mentors and mentees completed an evaluation that the
researcher prepared. Positive feedback was gleaned from both groups. In particular, the
mentees’ positive feedback included feeling at ease and the mentors’ feedback included
having gained self-confidence.
Iwasiw et al. (2009) referred to peer teaching briefly as a contemporary teaching-
learning strategy. The authors stated that group size should be small and that the cost
was low for this teaching strategy. Instructor preparation time was medium with a
learning curve of moderate for students. Learning curve referred to the rate that learning
should occur to reach the desired outcome. Learner engagement was defined as the
extent to which students are required to participate in the learning process for a particular
teaching strategy. The learner engagement was considered active with a learning curve
23
of steep. A steep learning curve was described as possibly needing a different teaching
strategy to be considered under certain circumstances. The intent of peer teaching was
described to help students develop understanding. Peer teaching has been just one
strategy for helping students during their education.
Student Charge Nurse
Isaacson and Stacy (2004) conducted a study examining management curriculum
with junior and senior undergraduate nursing students involved in a medical/surgical
clinical rotation. The seniors’ curriculum included a 90-hour management-focused
clinical course. The senior nursing students performed expanded charge nurse duties and
responsibilities while during the same clinical experience the junior baccalaureate
students functioned as the medical/surgical floor staff. The senior nursing students were
overseeing the junior nursing students with a ratio of one to four. Clinical instructors
functioned in a supervisory role with faculty-to-student ratio being one to 10. The senior
nursing students’ duties included creating an orientation plan and patient assignments for
the junior nursing students. The seniors would create the client assignments by following
instructions to keep the junior students’ individual specific clinical needs and abilities in
mind, reviewing client charts, having discussions with the nursing staff and the instructor,
and including multiple medication, procedures and co-morbidities. The juniors were
instructed to pose any questions regarding client assignments directly to the senior
nursing students. During the medical/surgical clinical rotations, Benner’s concepts of
novice to advanced beginner were utilized. The junior nursing students were novice as
they were exposed to nurse management theory and practice when the seniors mentored
them. Once these same juniors become seniors, and thus advanced beginners, they could
24
apply management theory as they themselves performed the senior expanded charge
nurse role. The seniors were required to participate in an extensive project that the
hospital’s department of continuous quality improvement could utilize. Another part of
the curriculum included the seniors being assessed on their ability to evaluate the junior
nursing students’ clinical performance. Requirements included weekly write-ups related
to the management process, the clinical experience with case studies on particular clients,
observations about nursing staff and students during clinical with problem-solving
critique along with constructive feedback, and evidence-based research and management
journals to support management concepts. As part of the curriculum, the seniors were
responsible for determining nursing staff education needs and creating in-service
education. They presented this education to the nursing staff with junior nursing students
in the audience, too. The seniors also were required to present evidence-based clinical
research to the juniors. A benefit to this curriculum noted by the faculty was that
students learned various leadership styles. Those students who became most proficient in
the role of manager learned that assessing situations, learning staffs’ individual abilities
and their own leadership skills were instrumental in their leadership success. Other
benefits to this clinical experience included junior/senior collaboration prepared the
junior students to communicate with the instructor without feeling as intimidated.
Seniors expressed benefits such as more confidence, increased self-esteem, improved
time management, and reciprocal relationship development with medical/surgical staff
along with clinical instructors. Instructors voiced being able to provide more time to
assist juniors with educational dispensation, and stated non-benefits were basically non-
existent. Due to the requirement of supervising two levels of students, there was a
25
suggestion to not place new faculty in this clinical role. This study revealed the use of
another teaching strategy that focused on undergraduate degree nursing programs.
Gore, Johnson and Wang (2015) conducted a comparison study of senior level
BSN nursing students’ perceptions of learned nursing leadership in a simulation setting
versus traditional acute-care inpatient clinical setting. A descriptive, correlational study
was conducted using a convenience sample of nursing students in leadership classes over
three semesters. The participants included fifth clinical semester BSN students at a
southeastern university who were in a leadership instructional and clinical course. All
nursing students enrolled in the course were required to participate in both the leadership
simulation setting and traditional clinical experiences held in a medical/surgical health
care setting. The order in which the students participated in either setting was randomly
selected. All the students that consented to participate in the study completed Leighton’s
(2015) Clinical Learning Environments Comparison Survey (CLECS) that examined
students’ perceived learning effectiveness at the end of each clinical course and the
completion of curriculum for each group for simulation as clinical time. The CLECS is a
29-item self-report survey that utilized a Likert scale of 1-4 and a not applicable choice.
Data analysis was completed using SPSS version 22.0 to determine students’ perceptions
of how well their learning needs were met in both settings. There was no statistically
significant difference between demographics of gender and age amongst the groups of
participants. The findings of this study were linked to the objectives for delegation,
prioritization, time management, and conflict resolution. There was not a significant
statistical difference in the overall scores between settings. However, there was a
perceived statistical preference in teaching-learning strategy for simulation. Both settings
26
were noted as being necessary for students to participate to have the students’ learning
needs met. Limitations recognized for this study included a need for multiple sites with
more diversity and a larger sample size. Potential for bias amongst participants’
responses could have been related to the order in which the students participated in the
simulation setting and clinical setting. Furthermore, research was suggested to
objectively measure both clinical settings. Participants were seniors from an
undergraduate degree nursing program and randomly selected to groups. Research on
utilization of simulation and clinical settings focusing on perceived learning about time
management and prioritization in ADN programs was not part of this study.
Kling (2010) examined the results of a senior-sophomore student curriculum that
included a clinical component with dual strategies as part of the leadership and
management course in a BSN program. Three hours of classroom and six hours of
clinical per week were required. The project experience involved 20% of the senior
students’ clinical hours, with participants completing the remaining clinical hours with a
preceptor nurse manager in a health care setting. The project experience involved senior
students in the role of charge nurse and nurse educator, directing client care for
hospitalized clients and overseeing sophomore nursing students. The senior student
nurses worked for two clinical days as peer mentors and leaders assisting sophomore
student nurses with time management, prioritization, skill technique, task completion, and
necessary documentation. Additional roles the senior student nurses performed were
making client assignments for the sophomore student nurses; leading pre-and post-
briefing; and guiding, instructing, correcting, and assessing sophomore students’ client
care. Thirty-four of the 36 senior nursing students completed the three broad question
27
category evaluation surveys that included each category having four Likert-type scale
statements. The three broad question categories included students’ perception of the
project in general; project meeting course objectives such as delegation, problem solving,
and time management; and the encouragement to demonstrate the role of nurse educator.
Of the senior student nurses that participated in the survey (n = 34), a few questions were
not completed. By the end of the clinical project, 91.2% of respondents (n = 34) reported
the overall perception as somewhat positive or extremely positive, with 8.8% reported as
being unsure about their feelings regarding the clinical experience. Regarding the
question about whether the clinical project met course objectives, respondents perceived
this to be true at least a little bit, with 50% rating this as very much so. Respondents
perceived the experience improved their problem-solving ability at least a little bit, with
64.7% rating it as very much so. Respondents perceived their critical thinking skills
improved at least a little bit (93.8%), with 71.9% rating very much so. After the clinical
experience, respondents stated having at least some (85.2%) interest in the role of nurse
educator, with 35.2% having extreme interest. The researcher stated the clinical
leadership project exceeded expectations. Historically, research on the perception of
utilization of leadership and management theory is not focused on results from ADN
programs.
Systematic Review
Secomb (2008) conducted a systematic review for providing the framework of
peer mentoring and learning in the clinical setting in an undergraduate nursing program
along with providing advantages and disadvantages to such an educational strategy. A
review search of health science and educational databases with the inclusion of the terms
28
‘peer’, ‘clinical education’, and ‘undergraduate’ was conducted. Publication dates after
1980 (2005 inclusive), English language and research papers were the set limitations.
Twelve articles met the inclusion criteria which were from five countries and four allied
health disciplines with research revealing mostly positive feedback about peer teaching
and learning (Aston & Molassiotis, 2003; Bos, 1998; Cortazzi, Jin, Wall & Brunel, 2001;
Currens & Bithell, 2003; DeClute & Ladyshewsky, 1993; Erikson, 1987; Faure, Unger &
Burger, 2002; Iwasiw & Goldenber, 1993; Ladyshewsky, 1995; Martin & Edwards,
1998; Schwab & Robinson, 1991; Yates, Cunningham, Moyle, & Wollin, 1997).
Advantages reported included an increase of student’s confidence in the clinical setting
and improvement in learning psychomotor skills and cognitive skills. A disadvantage
reported included poor student learning if personalities or learning styles clashed between
mentee and mentor. An additional disadvantage reported was mentees not having
individualized time with the clinical instructor. The articles hosted various forms of
methodology that included quantitative studies, but the majority used descriptive and
qualitative methods. Limitations discussed in many of the articles included sample and
design issues.
Stone, Cooper, and Cant (2013) conducted a systematic literature review also
related to peer learning in undergraduate nursing programs. Healthcare databases were
strategically searched for peer-reviewed articles, with research that involved peer
learning and students in BSN courses (in both clinical and theoretical settings) with the
defining terms of, a variation of, or a combination of ‘student nurse’, ‘undergraduate
nurse’, ‘peer learning’, ‘peer tutoring’, ‘peer mentoring’, ‘education’, and ‘opinion
leaders’. Set limitations included English language and the dates of 2000-2010.
29
Eighteen studies with various research methodologies were included (Broscious &
Saunders, 2001; Christiansen & Bell, 2010; Christiansen & Jensen, 2008; Cooke and
Moyle, 2002; Daley, Menke, Kirkpatrick & Sheets, 2008; Feingold, Cobb, Givens,
Arnold, Joslin & Keller, 2008; Goldsmith, Stewart, & Ferguson, 2006; Higgins, 2004;
Hughes, 2004; Hughes, Romick, Sandor et al., 2003; Horne, Woodhead Morgan,
Smithies, Megson & Lyte, 2007; Lin, Lu, Chung & Yang, 2010; Loke & Chow, 2007;
Morris & Turnbull, 2004; Ozturk, Muslu & Dicle, 2008; Rideout, England-Oxford,
Brown et al., 2002; Roberts, 2008; Siu, Spence Laschinger & Vingilis, 2005; Tiwari, Lai,
So & Yuen, 2006). The number of term variations affected reliability of the study for
peer learning and the various study methodologies. The articles included for review had
studied first to final year undergraduate nursing students with the majority of participants
being of the female gender and ranged from having 15 participants over a three-year
study to 365 participants over two-years. Methodologies ranged from eight being
qualitative, six quantitative, and four mixed methods. A comparison group was used by
eight of the studies. Sixteen of the 18 studies resulted in positive findings for peer
learning that included objectives being meet; encouragement of critical thinking and
problem solving along with autonomous study; increased communication skills;
improvement of cognitive and motor skills; and mutually beneficial interactions. There
was a difference noted for the interacting benefits for the mentors, which included an
increase in experience of leadership, reinforcement of prior knowledge, and recognition
of capabilities to be able to mentor or teach. Conclusion from the systematic review
included that supervision from faculty was stressed as an absolute for academic and
clinical learning. Recommendations for future research included larger sample sizes, and
30
more versatile curricula, courses, and settings to allow for an increase in the validity.
Through review of prior research, investigators can determine what changes are needed
to peer learning to advance students’ experiences and education.
Strengths and Limitations of Literature
Strengths
The literature review presented strengths of the peer mentoring strategy that
included a reduction in mentee’s anxiety and an increase in confidence (Zentz et al.,
2014; Roberts et al., 2009; Secomb, 2008), a reduction of feeling social isolation
expressed by the mentees (Christiansen & Bell, 2010), and mentors had confidence
strengthened and facilitation of transition into the role of professional nurse including
developing the role of manager (Zentz et al., 2014). Both mentors and mentees expressed
mutual support and increased education (Li et al., 2011; Sims-Giddens, et al., 2010).
Nurturing of relationships was noted as a result of peer mentoring (Sims-Giddens, et al.,
2010). The literature review presented strengths of the student charge nurse strategy that
included perception of more confidence, increased self-esteem, improved time
management, and reciprocal relationship development with medical/surgical staff along
with instructors, and exposure to various leadership styles.
Limitations
The literature review presented limitations related to a lack of hand-selection and
pairing of students for the peer mentoring experience (Li et al., 2011; Rapaport, 2014;
Christiansen & Bell, 2010), an examination of diversity and learning styles on PAL along
with faculty perception of PAL as to whether the model achieved learning objectives and
relieving faculty burden (Zentz et al., 2014), evaluation of student-to-student peer-
31
mentoring process with inclusion of the difference between self-selection and hand-
selected assigned mentoring groups (Sims-Giddens et al., 2010), and a lack of seeking the
participants’ perceptions related to the peer mentoring experience (Christiansen & Bell,
2010). Other limitations included not having enough students with clinical practice
experience (Li et al., 2011) and lack of study on the outcomes of ADN programs
implementing peer-mentoring strategies (Li et al., 2011; Zentz et al., 2014; Sims-Giddens
et al., 2010; Rapaport, 2014; Christiansen & Bell, 2010). The limitations the literature
review presented of the student charge nurse strategy included the need for multiple sites
for health care settings along with a more diverse and larger sample size. Gore et al.
(2015) suggested further research was needed for objective measurement in both
simulation and clinical settings.
Summary
Peer mentoring and student charge nurse experience strategies have been
presented in the literature review. Seven articles have presented studies conducted on
peer mentoring experiences and two articles on student charge nurse experiences with
summarization of strengths and weaknesses. One article presented a study for both
strategies; two articles were systematic reviews, and two were written textbook reviews.
Further research ideas were suggested such as hand-selection and pairing of participants
in peer mentoring, examining diversity and learning styles on PAL, examining sample
size and design issues, examining faculty perception of PAL in regards to achievement of
objectives, assessment of faculty perception of PAL in relieving faculty burden and
examination of participants’ perceptions of peer mentoring experience. Further research
into peer mentoring and student charge nurse experiences could assist nurse educators
33
CHAPTER III
Methodology
Nursing students have expressed that both the academic and clinical aspects of the
nursing program are mentally strenuous and anxiety producing. Literature has shown
peer-assisted learning (PAL) to be perceived as beneficial to mentors and mentees alike.
Literature has also shown student charge nurse experiences to be a beneficial strategy for
clinical education. The purpose of this study is to examine the post-clinical experience
perceptions of participants in an ADN program following a peer mentoring leadership
experience (PMLE) compared to the participants’ perceptions following a student charge
nurse experience (SCNE).
Study Design
The study was a mixed-method design and compared second-year PMLE (n = 3)
and first-year PMLE (n = 4) perceptions to second-year SCNE (n = 10) and first-year
SCNE (n = 24) perceptions of respective clinical experiences. The quantitative data was
analyzed with a descriptive analysis. Copies of the course objectives and instructions
related to the PMLE and the SCNE were obtained.
Setting and Sample
A PMLE, funded by a grant, was piloted at a southeastern United States
community college’s ADN program. The participants for the PMLE were hand-selected
by four nursing instructors and approved by the Dean of Nursing, Natural, and Health
Sciences. The nursing instructors chose to pair second-year nursing students (n=5) that
were registered in a health system concepts course with first-year nursing students (n=5)
that were registered in a health illness concepts course. The second-year students were
34
chosen based on personalities and whether the second-year students had leadership skills.
The five pairs were also chosen based on specific, individual rationales. The specific
rationale for one of the pair chosen was because both were English as second language
students. The second pair was specifically chosen based on gender; a male paired with a
male. The third pair was specifically chosen based on one of the students having a strong
clinical basis, but not as strong with academics and the one paired with this student was
strong academically, but weaker clinically. The fourth pair was chosen based on the
second-year student having an outgoing manner during client interactions and the first-
year student having a reserved manner during client interactions. The fifth pair was
chosen based on the second-year student’s academic and personal situation being
comparable to the first-year student’s academic and personal situation. This fifth pair
both had additional classes they took congruently outside of the ADN program and they
both started the nursing program the fall of the same year they graduated high school.
The peer mentoring leadership experience was carried out during medical/surgical
clinical rotations. All ten of the students completed six medical/surgical clinical
experiences for the PMLE. Three of the experiences were on a health care
medical/surgical unit and three were spent in the simulation laboratory at the community
college. The ADN program’s purpose for the clinical rotations was to provide a mutually
beneficial mentoring experience. The PMLE objectives were to provide students with an
understanding of the course concepts, assessment, documentation, communication,
delegation, collaboration, prioritization, and time management. These 10 participants
were the ones invited to participate in the survey for the outcomes of the PMLE.
35
The comparison group for the Outcomes of Peer Mentoring Study was comprised
of the non-PMLE remaining students in the nursing program. The comparison group
invitees consisted of the remaining second-year nursing students (n=25) registered in the
health system concepts course who participated in a charge nurse experience in which
they spent one-on-one time for eight hours with an on-duty designated health care unit
charge nurse during medical/surgical clinical rotations. These second-year student
participants spent five hours in a student charge nurse role meeting course management
and leadership objectives while overseeing first-year students’ patient care with clinical
faculty as resources. Another portion of the comparison group to be invited to participate
in the survey were the ones the second-year students oversaw during their charge nurse
role, the first-year students not involved in the PMLE (n=37).
Demographics
A total of 72 students were recruited for this study, which were five second-year
students and five first-year students in the PMLE along with 25 second-year students and
37 first-year students in the SCNE. The mean age of second-year students in the PMLE
was 26.4 years and of the first-year students was 26.8 years. The mean age of the first-
and second-year students in the PMLE was 26.6 years. The mean age of the second-year
students in the SCNLE was 30.16 years and of the first-year students was 34.89 years.
The mean age of the first- and second-year students in the SCNE was 32.53. Students in
the PMLE included eight females and two males. All 62 students in the SCNE were
females. The race of the students in the PMLE included Hispanic (n = 2), Russian (n =
1), and white (n = 7). The race of the students in the SCNE included African-American
(n = 4) and white (n = 58).
36
Design for Data Collection
Data collection was conducted by preparing envelopes with a copy of the
informed consent for participants, the appropriate confidential survey tool based on
participants’ clinical experience, and a return pre-addressed stamped envelope. The data
collection prepared envelope was mailed to the students with a statement included on the
informed consent requesting the survey be returned within one week.
The appropriate confidential survey tool to deliver was based first on whether the
participant was a mentor or a mentee, then second on whether the participant was
involved in the PMLE or the SCNE. Zentz et al. (2014) granted permission to utilize and
modify the original student mentor experience survey tool. Three nursing education
content experts reviewed the tool for face validity. The five mentors involved in the
PMLE received a modified confidential survey tool titled Peer Mentoring Experience
Survey NUR 212: Health System Concepts, the informed consent, and a return pre-
addressed stamped envelope. The five mentees involved in the PMLE received a
modified confidential survey tool titled Peer Mentoring Experience Survey NURS 112:
Health Illness Concepts, the informed consent, and a return pre-addressed stamped
envelope. Items addressed the experience from either the mentor or mentee perspective.
The 25 second-year students involved in the SCNE received a modified confidential
survey tool titled Student Charge Nurse Experience Survey NURS 212: Health System
Concepts, the informed consent, and a return pre-addressed stamped envelope. The 37
first-year students involved in the charge nurse experience received a modified survey
titled Student Charge Nurse Experience Survey NURS 112: Health Illness Concepts, the
informed consent, and a return pre-addressed stamped envelope. Items addressed the
37
experience from either the first or second year perspective.
Measurement Methods
The data collection tools were confidential modified surveys. The modifications
included having four survey tools adapted from the two original ones. Each survey tool
contained a 5-point Likert-type scale with 1= strongly disagree, 2 = disagree, 3 = neutral,
4 = agree and 5 = strongly agree as well as items requiring open-ended responses. There
was one specific survey for each group of participants. The data was collected within
months of the completion of all respective clinical experiences of the PMLE and SCNE.
Data Collection Procedure
The researcher conducted the data collection for the Outcomes of Peer Mentoring
Study. The data collection procedure included the researcher mailing via the United
States postal service the envelopes containing the informed consent and the confidential
survey tool based on clinical learning experience to the applicable participant of the
PMLE or the SCNE. The informed consent included a request to return the survey tool
within one week.
Protection of Human Subjects
Ethical consideration included obtaining approval from the Dean of Nursing,
Natural, and Health Sciences from the designated college and Institutional Review Board
approval. The participants of this study were provided an informed consent form. The
participants were protected throughout the implementation of the study. Included on the
informed consent was information that explained their participation in the study was
voluntary and they were under no obligation to participate. The completion and return of
the survey implied the participant’s consent to participate. The participants were
38
informed they had the right to withdraw at any time from the study and the decision
would not affect their current or future relationship with the community college.
Explanation on the informed consent also included information stating the study data
would not include the participant’s name and their identity would not be revealed while
the study was being conducted or when the study results were reported or published. The
demographics of age, gender and race were obtained from the community college and
were reported as aggregate data, with no individual information shared. All study data
was stored in a locked area with data entered into a password-protected computer. At the
completion of the study, all surveys were turned into Gardner-Webb University where
they are stored in a locked area for three years and then destroyed.
Data Analysis
Quantitative Data
Quantitative data was entered into International Business Machines (IBM)® SPSS
software version 24 for descriptive analysis to obtain mean scores as well as the
individual item scores.
Qualitative Data
The researcher reviewed qualitative data from the open-ended responses and
identified common themes.
Second-year Students’ PMLE Open-ended Responses
Second-year students that responded to the PMLE open-ended response portion of
the survey completed the following statements:
The most positive part of being a second-year student peer mentor was…
The most difficult part of being a second-year student peer mentor was…
39
Suggestions for future student peer mentoring experiences…
First-year Students’ PMLE Open-ended Responses
First-year students that responded to the PMLE open-ended response portion of
the survey completed the following statements:
The most helpful part of interacting with the second-year student peer mentor was…
The least helpful part of interacting with the second-year student peer mentor was…
Suggestions for future student peer mentoring experiences…
Second-year Students’ SCNE Open-ended Responses
Second-year students that responded to the SCNE open-ended response portion of
the survey completed the following statements:
The most positive part of being a second-year student charge nurse was…
The most difficult part of being a second-year student charge nurse was…
Suggestions for future student charge nurse experiences…
First-year Students’ SCNE Open-ended Responses
First-year students that responded to the SCNE open-ended response portion of
the survey completed the following statements:
The most positive part of interacting with a second-year student charge nurse was…
The most difficult part of interacting with a second-year student charge nurse was…
Suggestions for future student charge nurse experiences…
40
CHAPTER IV
Results
The stressful and demanding aspects of nursing programs have been expressed by
nursing students to include not only the classroom, but also the clinical experiences.
Finding strategies to decrease threatening aspects of learning to allow for a perceived
improvement in the learning process has been described in the literature to include peer
mentoring. The purpose of the Outcomes of Peer Mentoring Study was to examine the
perceptions of second- and first-year nursing students in an ADN program in regards to
the peer mentoring leadership experience (PMLE) in comparison to those participants
involved in the student charge nurse experience (SCNE).
Sample Characteristics
A total of 72 surveys were distributed with a total of 41 participants completing
the questionnaires for a return rate of 57% with a total of 31 unexplained non-responses
for a non-participation rate of 43%. Table 1 presents survey distribution and return data.
The participants that returned questionnaires included second-year PMLE participants (n
= 3 out of 5, 60%); first-year PMLE participants (n = 4 out of 5, 80%); second-year
SCNE participants (n = 10 out of 25, 40%); and first-year SCNE participants (n = 24 out
of 37, 65%).
Table 1
Survey Distribution and Return Data
# Surveys # Respondents % Rate # Non-
respondents % Rate
72
41
57%
31
43%
41
Table 2 presents participation numbers per student year level and clinical
experience.
Table 2
Participation Numbers per Student Year Level and Clinical Experience
Year Level & Type
of Experience # Invited # Respondents % Rate
Second-year PMLE n = 5 3 60%
First-year PMLE n = 5 4 80%
Second-year SCNE n = 25 10 40%
First-year SCNE n = 37 24 65%
Major Findings
Quantitative data analysis revealed the second-year respondents in the PMLE
strongly agreed it was an effective way to demonstrate the roles of client advocate (93%,
M = 4.67, SD = .577), educator (93%, M = 4.67, SD = .577), caregiver (100%, M = 5.0,
SD = .000), prioritization of client care (100%, M = 5.0, SD = .000), and communicator
(86.6%, M = 4.33, SD = .577). In addition, 100% (M = 5.0, SD = .000) of respondents
strongly agreed that the PMLE experience increased their confidence in the clinical
setting and 100% also strongly agreed that it was an effective way to demonstrate time
management (M = 5.0, SD = .000). Furthermore, 100% of respondents strongly agreed it
was an effective way to demonstrate the professional role of leader (M = 5.0, SD .000).
In regards to the experience being an effective way to demonstrate the professional role
42
of multi-disciplinary team relationship builder, 86.6% (M = 4.33, SD = .577) strongly
agreed. Overall mean scale score was 4.74. Descriptive statistics for this group are
reported in Table 3.
Table 3
Second-year PMLE Individual Item Mean Scores and Overall Mean Score
Descriptive Statistics
N Minimum Maximum Mean Std.
Deviation
Demonstrate Role of
Client Advocate
3 4 5 4.67 .577
Demonstrate Role of
Educator
3 4 5 4.67 .577
Demonstrate Role of
Caregiver
3 5 5 5.00 .000
Demonstrate Role of
Prioritization of Client
Care
3 4 5 4.67 .577
Demonstrate Role of
Communicator
3 4 5 4.33 .577
Increased Confidence
3 5 5 5.00 .000
Demonstrate Time
Management
3 5 5 5.00 .000
Demonstrate Role of
Leader
3 5 5 5.00 .000
Demonstrate Role of
Multi-Disciplinary
Team Relationship
Builder
3 4 5 4.33 .577
Overall Mean Scale
Score 4.74
Valid N (list wise) 3
43
Quantitative data analysis revealed the first-year participants in the PMLE
strongly agreed the experience was an effective way to demonstrate the roles of client
advocate (90%, M = 4.50, SD = .577), educator (95%, M = 4.75, SD = .500), caregiver
(90%, M = 4.50, SD = .577), prioritization of client care (85%, M = 4.25, SD = .957), and
communicator (90%, M = 4.50, SD = .577). In addition, first-year participants strongly
agreed with the statement of interacting with the second-year peer mentor increased my
self-confidence in the clinical setting (85%, M = 4.25, SD = .957) and increased my
learning to time manage (80%, M = 4.00, SD = 1.155). Furthermore, first-year
participants in the PMLE strongly agreed with the second-year peer mentor
demonstrated the professional role of leader (90%, M = 4.50, SD = 1.00) and multi-
disciplinary team relationship builder (85%, M = 4.25, SD = .957). Overall mean scale
score was 4.39. Descriptive statistics for this group are reported in Table 4.
44
Table 4
First-year PMLE Individual Item Mean Scores and Overall Mean Score
Descriptive Statistics
N Minimum Maximum Mean Std.
Deviation
Increased Learning to
be Client Advocate
4 4 5 4.50 .577
Increased Learning to
be Educator
4 4 5 4.75 .500
Increased Learning to
be Caregiver
4 4 5 4.50 .577
Increased Learning to
Prioritize Client Care
4 3 5 4.25 .957
Demonstrated Role
of Communicator
4 4 5 4.50 .577
Increased Confidence
in Clinical Setting
4 3 5 4.25 .957
Increased Learning to
Time Manage
4 3 5 4.00 1.155
Demonstrated
Professional Role of
Leader
4 3 5 4.50 1.000
Demonstrated
Professional Role of
Multi-Disciplinary
Team Relationship
Builder
4 3 5 4.25 .957
Overall Mean Scale
Score
4.39
Valid N (list wise) 4
45
Quantitative data analysis of both the first- and second-year PMLE aggregate mean
scores further assisted in providing answers to the research questions. The combined
respondents (n = 7) strongly agreed with the individual item questions as follows: client
advocate (91.4%, M = 4.57, SD = .535), educator (94.2%, M = 4.71, SD = .488),
caregiver (94.2%, M = 4.71, SD = .488), prioritize client care (88.6%, M = 4.43, SD =
.787), communicator (88.6%, M = 4.43, SD = .535). The combined students strongly
agreed that self-confidence was increased in the clinical setting (91.4%, M = 4.57, SD =
.787) and time management improved (88.6%, M = 4.43, SD = .976). Furthermore,
94.2% strongly agreed it was an effective way to demonstrate the professional role of
leader (M = 4.71, SD = .756) and 85.5% strongly agreed it was an effective way to
demonstrate the role of multi-disciplinary team relationship builder (M = 4.29, SD =
.756). Overall mean scale score was 4.54. Descriptive statistics for the aggregate PMLE
group are reported in Table 5.
46
Table 5
First- and Second-year PMLE Aggregate Mean Scores and Overall Mean Score
Descriptive Statistics
N Minimum Maximum Mean Std.
Deviation
Client Advocate 7 4 5 4.57 .535
Educator 7 4 5 4.71 .488
Caregiver 7 4 5 4.71 .488
Prioritize Client Care 7 3 5 4.43 .787
Communicator 7 4 5 4.43 .535
Self-Confidence 7 3 5 4.57 .787
Time Manage 7 3 5 4.43 .976
Leader 7 3 5 4.71 .756
Multi-Disciplinary
Team Relationship
Builder 7 3 5 4.29 .756
Overall Mean Scale
Score 4.54
Valid N (list wise) 7
47
Quantitative data analysis revealed the second-year participants in the SCNE
strongly agreed that the experience was an effective way to demonstrate the roles of
client advocate (68%, M = 3.40, SD = .843), educator (84%, M = 4.20, SD = .789),
caregiver (74%, M = 3.70, SD = .483), prioritization of client care (84%, M = 4.20, SD =
.919), and communicator (90%, M = 4.50, SD = .527). In addition, the second-year
participants strongly agreed that acting as a second-year student charge nurse increased
the respondents’ self-confidence in the clinical setting (82%, M = 4.10, SD = .876) and
was an effective way to demonstrate time management (78%, M= 3.90, SD = .876).
Furthermore, 82% of the second-year student charge nurse participants strongly agreed
the experience was an effective way to demonstrate the professional roles of leader (M =
4.10, SD = 1.197) and 74% strongly agreed it was an effective way to demonstrate the
role of multi-disciplinary team relationship builder (M = 3.70, SD = 1.160). Overall mean
scale score was 3.98. Descriptive statistics for this group are reported in Table 6.
48
Table 6
Second-year SCNE Individual Item Mean Scores and Overall Mean Score
Descriptive Statistics
N Minimum Maximum Mean Std.
Deviation
Demonstrate Role of
Client Advocate
10 2 5 3.40 .843
Demonstrate Role of
Educator
10 3 5 4.20 .789
Demonstrate Role of
Caregiver
10 3 4 3.70 .483
Demonstrate Role of
Prioritization of
Client Care
10 3 5 4.20 .919
Demonstrate Role of
Communicator
10 4 5 4.50 .527
Increased Confidence
in Clinical Setting
10 3 5 4.10 .876
Demonstrate Time
Management
10 2 5 3.90 .876
Demonstrate
Professional Role of
Leader
10 2 5 4.10 1.197
Demonstrate Role of
Multi-Disciplinary
Team Relationship
Builder
10 2 5 3.70 1.160
Overall Mean Scale
Score
3.98
Valid N (list wise) 10
49
Quantitative data analysis revealed the advantages the first-year participants in the
SCNE strongly agreed that interacting with the second-year student charge nurse
increased the respondents’ learning to be a client advocate (74.2%, M = 3.71, SD =
1.083), educator (71.6%, M = 3.58, SD = 1.060), caregiver (77.6%, M = 3.88, SD = .947),
and to prioritize client care (82.6%, M = 4.13, SD = .947). Respondents strongly agreed
that the second-year student charge nurse demonstrated the professional role of
communicator (84.2%, M = 4.21, SD = .779). In addition, 76.6% of first-year
participants strongly agreed that the SCNE increased the respondents’ self-confidence in
the clinical setting (M = 3.83, SD = 1.204) and 75.8% strongly agreed the experience
increased the respondents’ learning to time manage (M = 3.79, SD = .977). Furthermore,
respondents strongly agreed the second-year student charge nurse demonstrated the
professional roles of leader (82.6%, M = 4.13, SD = .900) and multi-disciplinary team
relationship builder (78.4%, M = 3.92, SD = .830). Overall mean scale score was 3.91.
Descriptive statistics for this group are presented in Table 7.
50
Table 7
First-year SCNE Individual Item Mean Scores and Overall Mean Score
Descriptive Statistics
N Minimum Maximum Mean Std.
Deviation
Role of Client
Advocate
24 1 5 3.71 1.083
Role of Educator
24 2 5 3.58 1.060
Role of Caregiver
24 2 5 3.88 .947
Role of Prioritization
of Client Care
24 2 5 4.13 .947
Role of
Communicator
24 2 5 4.21 .779
Increased Confidence
24 2 5 3.83 1.204
Time Management
24 2 5 3.79 .977
Role of Leader
24 2 5 4.13 .900
Role of Multi-
Disciplinary Team
Relationship Builder
24 2 5 3.92 .830
Overall Mean Scale
Score
3.91
Valid N (list wise) 24
51
Quantitative data analysis of both the first- and second-year SCNE aggregate
mean scores further assisted in providing answers to the research questions. The
combined respondents (n = 34) strongly agreed with the individual item questions as
follows: client advocate (72.4%, M = 3.62, SD = 1.015), educator (75.2%, M = 3.76, SD
= 1.017), caregiver (76.4%, M = 3.82, SD = .834), prioritize client care (83%, M = 4.15,
SD = .925), and communicator (85.8%, M = 4.29, SD = .719). For the combined
students, 78.2% strongly agreed the experience increased self-confidence (M = 3.91, SD
= 1.111) and 76.4% strongly agreed that time management improved (M = 3.82, SD =
.936). Furthermore, 82.4% of the students strongly agreed the experience was an
effective way to demonstrate the role of leader (M = 4.12, SD = .977) and 77% strongly
agreed it was an effective way to demonstrate the role of multi-disciplinary team
relationship builder (M = 3.85, SD = .925). Overall mean scale score was 3.93.
Descriptive statistics for the aggregate SCNE group are reported in Table 8.
52
Table 8
First- and second-year SCNE Aggregate Mean Scores and Overall Mean Score
Descriptive Statistics
N Minimum Maximum Mean Std.
Deviation
Client Advocate
34 1 5 3.62 1.015
Educator
34 2 5 3.76 1.017
Caregiver
34 2 5 3.82 .834
Prioritization of
Client Care
34 2 5 4.15 .925
Communicator
34 2 5 4.29 .719
Confidence
34 2 5 3.91 1.111
Time Management
34 2 5 3.82 .936
Leader
34 2 5 4.12 .977
Multi-Disciplinary
Team Relationship
Builder
34 2 5 3.85 .925
Overall Mean Scale
Score
3.93
Valid N (list wise) 34
Second-year Students’ PMLE Open-ended Responses
Advantages, disadvantages, and suggestions are revealed through the qualitative
data responses to assist in answering the research questions. The most predominant
themes noted from the responses for each statement are described. Factual results and
supporting respondent quotes are included.
53
The most positive part of being a second-year student peer mentor. Two major
themes were prevalent during the analysis of responses; the first was being a role model
and the second was assisting with education. One student stated, “Sharing my experience
and knowledge with the first-year student was very rewarding. I feel that I gained as
much if not more from the experience as the first-year student.” Another student stated,
“Educating them on how to improve skills/time management based on past experience.”
The most difficult part of being a second-year student peer mentor. Three
separate topics emerged from the responses for this statement. The first was having
patience for the learning process to occur. The second was the mentor did not know role
expectations. The last theme was meeting mentors’ required written objectives for the
clinical aspect of the course. The first mentor wrote, “It was hard to watch and let them
(mentees) figure things out for themselves.” The second mentor wrote, “Learning what
was expected of me as the second-year student.” The third student wrote, “Managing
paperwork. Each week there was some kind of issue with getting the first-year student’s
paperwork back so I could review it.”
Suggestions for future student peer mentoring experiences. Three major themes
emerged during analysis of these responses. The first theme was related to changing the
timeframe to a whole shift rather than just four hours. Another suggestion was to set
expectations for the experience. The last suggestion was to have a mentor’s check-off
sheet. A student stated, “Make it a full day, so that the senior student can see the first
year student’s progress throughout the day.” A second student shared, “I did not enjoy
coming in at 11am because the students had already received report and done their head
to toe assessments. Most of the students had already prioritized patient care and done
54
medication administration.” Another student shared, “Have a more detailed list of things
for them to do”. A respondent stated, “Explain the experience to everyone as a whole
during orientation and again prior to the clinical experience so that everyone is on the
same page.” One respondent shared, “Make the best of the experience. For first-year
students, the second year students are not trying to be bossy, etc.; they just reiterate parts
that were difficult for them.” Another student stated, “Instead of second-years having to
review paperwork each week, maybe having a ‘review/check-off’ sheet or list that we
could go over with them (first-year students) each week, that we could reinforce for
improvement.”
First-year Students’ PMLE Open-ended Responses
Advantages and disadvantages to this particular clinical strategy helped to answer
more of the research questions along with additional suggestions. The comments noted
from the responses for each statement follow. Supporting quotes from students are
included also.
The most helpful part of interacting with the second-year student peer mentor.
Tips on organizing, prioritizing or time management; being able to ask second-year
student questions; and the benefit of having a second person available to teach were
prominent themes noted. A respondent stated, “I was most benefited by the student
charge nurse with completing my care plans which was a struggle for me in the
beginning.” Another respondent shared, “She guided me with time management
regarding obtaining blood sugar levels. She provided supporting rationale. She
explained and supported prioritization of client care and encouraged behavior for client
advocacy. She remained professional and evoked respect in her role.” Another student
55
stated, “It allowed me to ask questions that I was not comfortable asking my instructor.
Also, the student was more available than my instructor because she wasn’t being pulled
in as many directions.” One student shared, “The teacher was ‘spread so thin’ with a
group of students; we got to actually learn about more.”
The least helpful part of interacting with the second-year student peer mentor.
Themes that emerged from responses included: feeling rushed and given orders, need for
role expectations, and disagreement on prioritization. One respondent stated, “I was
being rush(ed), and sometimes it was like I was being ordered instead of being guided.”
One student shared, “The peer mentors seemed to not have enough to do and mine would
get in my way or just disappear. I feel like my peer mentor could have handled two
students to help keep busy.” Another respondent answered, “The least helpful part was
with time management. There were times I felt I needed to do certain things before doing
other(s), but she felt the others were important.” One student shared, “I didn’t have a
least helpful part interacting with the second-year student peer mentor.”
Suggestions for future student peer mentoring experiences. One major theme
emerged to provide orientation for the peer mentoring program with expectations. One
student shared, “I think that the second year students should be explained that we are still
not in their level, and we need more time to do our job.” A second student stated, “Off
site time to get to know my mentor. Maybe 30-60 minutes talking about the peer
mentoring program, expectations, and sometime doing ice breakers to facilitate a bond or
rapport would help.” Two students responded to keep the peer mentor program. One
such respondent shared, “I think this year went great! I loved it! Just having that one-on-
one with someone really helped with confidence and knowledge!”
56
Second-year Students’ SCNE Open-ended Responses
Positive and negative aspects of this clinical teaching strategy were revealed
along with suggestions to provide answers to the research questions. The most
predominant themes noted from the responses for each statement are described. Relevant
supporting quotes from the students are provided.
The most positive part of being a second-year student charge nurse. Four major
themes were prevalent during analysis of responses: helping, teaching, providing
feedback, and sharing experiences. One student stated, “I was able to help first year
students use their critical thinking skills to come up with answers to their questions. The
experience helped me to realize how much information I knew myself.” A second
student stated, “It helped me to refresh my skills through teaching the freshman as well as
build my prioritization and delegation skills.” Another respondent stated, “Empathizing
with and helping students and patients. It was rewarding to know that my help and input
was appreciated.” Yet another student stated, “I was able to give feedback and offer any
help to the freshman.”
The most difficult part of being a second-year student charge nurse. The most
prevalent responses included: splitting time between students; not having role
expectations; noting that some first-year mentees appeared intimidated by mentors; and
managing more patients than mentor was accustomed to. Of the responses to this
statement, the most predominant one was not having role expectations. One respondent
stated, “Not knowing what to do at times.” Another respondent on this same theme
shared, “The students’ understanding of our role as a student charge nurse versus their
instructor’s role; along with the instructors’ understanding of our role.” One student
57
stated, “Not really understanding exactly what the expectations were for us, not very
clear. I worked with two different instructors who each expressed different goals for the
outcome of the experience.” In regards to the theme of intimidation, a second-year
student stated, “Students (not all) seemed intimidated.” In regards to the theme of
managing more patients, one student stated, “Managing six plus patients when I had been
used to having only two to four patients.”
Suggestions for future student charge nurse experiences. Several themes
prevailed for this statement that included: make the experience a full shift; increase the
number of days and make them consecutive for the experience; clearly define roles and
set expectations; encourage first-year students to utilize the second-year student in this
role. Of the suggestions, the most predominant one mentioned was to clearly define and
set expectations. One respondent stated, “Make it a full day, so that the senior student
can see the first year student’s progress throughout the day.” Another student stated,
“Having more than one day would be beneficial.” In regards to the expectations theme,
one student stated, “Explain the experience to everyone as a whole during orientation and
again prior to the clinical experience so that everyone is on the same page.”
First-year Students’ SCNE Open-ended Responses
Further answers are provided for the research questions related to advantages and
disadvantages of this specific clinical strategy along with suggestions for potential future
SCNE. The most predominant themes noted from the responses for each statement are
described. The most relevant respondents’ statements are included for support.
The most positive part of interacting with a second-year student charge nurse.
The major themes emerging from this statement included: being able to ask questions
58
without feeling intimidated; increased mentees’ confidence; mentor was more readily
available; gaining insight and perspective; encouragement and positive reinforcement;
roles were relatable; and gaining “tips and advice” on time management, prioritization
and care plan creations while providing supporting rationale. One student stated,
“Overall advice on continuing the program.” One respondent stated, “Seeing how much
a second-year charge nurse could do, helped first-year student realize what she/he could
achieve.” Another respondent stated, “The environment seemed more relaxed.” The
most predominant statement was the role as student nurses were relatable.
The most difficult part of interacting with a second-year student charge nurse.
Three major themes for this statement were related to timeframe, role expectations, and
mentor-mentee ratio: the four hour timeframe for student charge nurses being in clinical
was not long enough; having to give report to two different student charge nurses
(because of timeframe); mentors did not know their role expectations; and too many
mentees per mentor. One student stated, “There was very little time with her. Having
four or more students per mentor left little time with each of us.” Another student stated,
“It was also hard to find the charge at times between all of the other students needing
advice, etc.” Other frequent responses included: mentors were intimidating; mentors did
not take initiative; and mentors did not know how to perform certain tasks or patient care.
One student stated there was no contact with the student charge nurse. Another stated, “I
didn’t feel it was beneficial for the first-years, but did understand the benefit for the
second-years.” The opposite was seen when five respondents stated there was not
anything difficult about interacting with the second-year student charge nurse.
59
Suggestions for future student charge nurse experiences. Major themes that
emerged during analysis of this statement included: timeframe be extended to a full shift
and extend to two consecutive days; reduce student charge nurse and first-year student
ratio; set expectations including how to provide feedback, what to include such as tips
and advice, how to spread time between all mentees; student charge nurse to plan on
introducing themselves to the assigned patients; and have a debriefing meeting at end of
clinical day with student charge nurse. The most predominant theme was timeframe.
Four respondents did not have any suggestions and said the SCNE was a good experience
and should be continued. One student stated, “Having them stay the whole day instead of
just half of the day. When just staying half of the day it seems rushed and just when you
get started with them, they are leaving.” Another statement in regards to timeframe was,
“I think it would be nice to have one senior student charge nurse per student per clinical
day. Sometime we had two and it took more time to bring them up to speed and
repeating things over.” A third student continued the time frame theme, “Extend the time
frame to one to two days with the same clinical group in the same week.”
Summary
This research study obtained quantitative and qualitative data from respondents
that chose to answer nine Likert-type scale survey questions along with three open-ended
response statements. Aggregate scores as well as individual item scores were analyzed
from the 5-point Likert-type scale responses to obtain appropriate data to answer the
research questions that are further discussed in Chapter V. Statistical analysis was
performed per item on the survey for each specific student level per each clinical
60
experience group. The open-ended response statements were reviewed and clustered
according to themes that emerged.
61
CHAPTER V
Discussion
The purpose of this study was to compare students’ perceptions of the peer
mentoring leadership experience (PMLE) and the student charge nurse experience
(SCNE) to provide nurse educators in ADN programs with information to assist in
determining whether to include one, both or none of the strategies as part of the future
curriculum. Through respondents’ answers to the nine Likert-type survey questions,
quantitative data was analyzed using IBM® SPSS® software version 24 for descriptive
analysis. Answers to the three open-ended response statements on the survey were
reviewed for emerging themes and clustered. Discussion of the results of the statistical
analyses related to the research questions follows.
Implication of Findings
Implications of findings from the quantitative analysis indicated the PMLE
respondents perceived the experience as more advantageous than the respondents of the
SCNE based on their answers to the surveys. Second-year respondents of the PMLE
individual items scored a mean of 4.33-5.00 to the nine 5-point Likert-type scale survey
questions compared to the second-year respondents of the SCNE that scored a mean of
3.40-4.50. The first-year respondents of the PMLE individual items scored a mean of
4.25-4.75 to the nine 5-point Likert-type scale survey questions compared to the first-year
respondents of the SCNE that scored a mean of 3.58-4.21. The aggregate mean scores of
the PMLE respondents were 4.29-4.71 compared to the SCNE aggregate mean scores of
3.62-4.29. This information is important to provide nurse educators of ADN programs
with data to determine which clinical teaching strategy was perceived more positively.
62
The articles described in the literature review provided advantages and disadvantages that
were similar to ones revealed in this study. An advantage discussed in the literature that
was also found in the study included mentors and mentees strongly agreed the peer
mentoring experience provided an effective way to demonstrate the role of educator
(Zentz et al., 2014) 94.8%; Outcomes of Peer Mentoring Study, 94.2%). Other
similarities included PMLE first-year respondents strongly agreed that the clinical
experience increased my self-confidence in the clinical setting (85%) and increased my
learning to time manage (80%) compared to Zentz et al. (2014) finding the answers to be
78.1% and 74.2% respectively, while Sprengel and Job (2004) stated the peer mentoring
experience allowed for gained self-confidence. Differences noted were first-year student
PMLE respondents strongly agreed the experience was an effective way to demonstrate
the role of educator (95%) compared to Zentz et al. (2014) finding 79.1% from
sophomore BSN respondents.
Respondents from both the PMLE and SCNE were found to have some similar
themes to the open-ended response statements as were found in the literature review
studies. Some of these included similar responses to advantageous aspects of being a
student peer mentor such as the mentor learning or realizing how much they themselves
knew while helping or teaching the mentee (Li et al., 2011; Sims-Giddens et al., 2010;
Joubert & de Villers, 2015). On the other hand, SCNE advantageous aspects from the
open-ended statements that were similar to the ones found in the literature review
included being able to help, teach, provide feedback and share experiences, but note the
difference from PMLE in that the peer mentors realized how much they themselves knew
through helping or teaching the mentee. Another similarity noted from the literature
63
review to the PMLE included role modeling (Sims-Giddens et al., 2010). One theme that
was found in the PMLE, SCNE and literature review was increased self-confidence
(Roberts et al., 2009). A disadvantage that was found in the literature review and also the
PMLE included time frame issues (Rapaport, 2014). Two suggestions from the PMLE
respondents that were also noted during the review of the literature included having an
orientation to set expectations and training (Joubert & de Villers, 2015; Roberts et al.,
2009) and a decreasedratio of mentor to mentee (Joubert & de Villers, 2015).
Application to Conceptual Framework
The key concepts from the conceptual framework of SPAM were appropriate for
this study and overall the study findings were congruent. Results from this study that
relate to the conceptual framework of SPAM included that peer mentoring would
increase first-year mentees’ deep learning of being a client advocate, educator, and
caregiver; problem solving skills defined as prioritizing client care and time management,
and increase self-confidence with respondents having affirmed this by having answered
80-95% strongly agree. Other results from the MSN thesis study that relate to key
concepts from SPAM included reinforcement of second-year mentors’ nursing education
through teaching peers strategies for problem solving defined as prioritizing client care
and time management. The second-year mentors affirmed these key concepts from
SPAM by having answered strongly agree 100% to the questions specifically related to
prioritizing client care and time management. Open-ended responses also affirmed that
by teaching peers, the mentors would have nursing education reinforced. Key concepts
from SPAM also included the second-year mentors would have improved skills for
communicating, leadership, and multi-disciplinary team relationship building. The
64
second-year PMLE respondents affirmed that the experience was an effective way to
demonstrate the professional roles of leader and multi-disciplinary team relationship
builder along with the demonstration of the role of communicator (86.6-100%).
Limitations
A limitation of this study is that it was conducted at one community college and
the numbers in the different types of experiences were small. The PMLE survey created
for the first-year students had inconsistent wording on the first statement for the open-
ended response and was written with the word ‘positive’ instead of ‘helpful’ as was on
the other three surveys. The surveys were mailed weeks to months after the experiences.
Implications for Nursing
The results of this study have implications for nurse educators’ teaching
strategies. These findings are linked to the objectives for leadership experience of client
advocate, caregiver, and prioritization of client care, time management, communicator,
leader, multi-disciplinary team relationship builder, and self-confidence. As the shortage
of nursing faculty continues to compound the nursing shortage, there is still a great need
for those graduating nursing students to have appropriate leadership skills for the nursing
workforce. Having adequate clinical leadership experiences provided in ADN programs
is essential for novice post-graduate nurses to begin their nursing careers.
Recommendations
Recommendations that could be beneficial in similar research would be
conducting a longitudinal study with a larger sample size to provide a larger quantity of
data for perhaps more accurate results. Distributing the post-experience surveys prior to
the course semester end would possibly facilitate a larger response number. The study
65
instrument was a self-report survey and as such, the results were self-reported
perceptions. Conducting a study after suggestions for improvement have been reviewed
and potentially implemented to compare if students’ perceptions of the clinical strategies
change would be another idea.
Conclusion
The purpose of this study was to compare students’ perceptions of the PMLE and
the SCNE to provide nurse educators in ADN programs with information to assist in
determining teaching strategies to implement. The pilot study demonstrated that students
perceived the PMLE was a more beneficial teaching strategy than SCNE. Further
research is required for objective measurement in both leadership experiences. The
findings of this study support using PMLE as a beneficial teaching strategy.
66
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